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Identification and management of prisoners with severe psychiatric illness by specialist mental health services

Published online by Cambridge University Press:  23 October 2012

J. Senior ,
L. Birmingham ,
M. A. Harty ,
L. Hassan ,
A. J. Hayes ,
K. Kendall ,
C. King ,
J. Lathlean ,
C. Lowthian  and
A. Mills
...Show all authors
J. Senior*
Affiliation:
The University of Manchester, UK
L. Birmingham
Affiliation:
The University of Southampton, UK
M. A. Harty
Affiliation:
Institute of Psychiatry, King's College London, UK
L. Hassan
Affiliation:
The University of Manchester, UK
A. J. Hayes
Affiliation:
The University of Manchester, UK
K. Kendall
Affiliation:
The University of Southampton, UK
C. King
Affiliation:
The University of Manchester, UK
J. Lathlean
Affiliation:
The University of Southampton, UK
C. Lowthian
Affiliation:
The University of Manchester, UK
A. Mills
Affiliation:
The University of Auckland, New Zealand
R. Webb
Affiliation:
The University of Manchester, UK
G. Thornicroft
Affiliation:
Institute of Psychiatry, King's College London, UK
J. Shaw
Affiliation:
The University of Manchester, UK
*
*Address for correspondence: Dr J. Senior, Offender Health Research Network, Centre for Mental Health and Risk, 2.317, Jean McFarlane Building, The University of Manchester, Manchester M13 9PL, UK. (Email: [email protected])
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Abstract

Background

The prevalence of mental disorders among prisoners is considerably higher than in the general population. This is an important public health issue as the vast majority of prisoners stay in custody for less than 9 months and, when not in prison, offenders' lifestyles are frequently chaotic, characterized by social exclusion, instability and unemployment. Multi-disciplinary mental health inreach services were introduced to target care towards prisoners with severe mental illness (SMI) in a similar way to that provided by Community Mental Health Teams outside prison. The aim was to establish the proportion of prisoners with SMI who were assessed and managed by prison mental health inreach services.

Method

A two-phase prevalence survey in six prisons in England measured SMI upon reception into custody. Case-note review established the proportion of those with SMI subsequently assessed and treated by inreach services.

Results

Of 3492 prisoners screened, 23% had SMI. Inreach teams assessed only 25% of these unwell prisoners, and accepted just 13% onto their caseloads.

Conclusions

Inreach teams identified and managed only a small proportion of prisoners with SMI. Prison-based services need to improve screening procedures and develop effective care pathways to ensure access to appropriate services. Improved identification of mental illness is needed in both the community and the Criminal Justice System to better engage with socially transient individuals who have chaotic lifestyles and complex needs.

Keywords

Epidemiologyforensic psychiatryhealth caremental health inreach servicesprison healthprisonerssevere mental illnesstwo-phase prevalence survey
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 7 , July 2013 , pp. 1511 - 1520
Copyright
Copyright © Cambridge University Press 2012 

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